Surgical instrument and method of use for releasing soft tissue

ABSTRACT

A surgical instrument for use in releasing soft tissue within the human body. The surgical instrument has a handle with proximal and distal ends with a tube connected to the distal end. The surgical instrument also includes a blade member that slidingly engages the tube moving along the length of the tube to cut soft tissue. Further included in the surgical instrument is a guard member that is attached to the blade member. The guard member has a hood portion and a capture portion. The hood portion is connected to the blade member with the distally positioned capture portion acting to displace surrounding tissue while capturing certain soft tissue structures resulting in the blade member being in operative position to cut and release the soft tissue. A surgical instrument kit including a plurality of modular surgical instruments and method for releasing soft tissue using the surgical instrument are also disclosed.

TECHNICAL FIELD

The present invention relates to the field of surgery, and moreparticularly, to surgical instruments and surgical methods forperforming the release of constricted soft tissue or stenotic tissuewithin the body of a patient.

BACKGROUND OF THE INVENTION

Constriction of soft tissue within the body is a problem that affectspeople of all ages. For example, stenosing tendovaginitis, or triggerfinger as the condition is commonly known, is an abnormal conditionaffecting the flexor tendons of the hand and affects people of all ages.The problem involves the tendon system of the hand and can range from asimple nuisance to completely disabling the function of the hand. Thetendon system of the hand involves an extremely intricate and finelymatched pulley system to allow each finger joint to move through acomplete forceful arc of motion. The pulley system and tendon systemdysfunction when a finger develops triggering (trigger finger). Themismatch or dysfunction causes a stenosis or tightening, this can berelated to the tendon or the pulley. More specifically, the greatestexcursion of the tendon occurs at the A-1 pulley and it is this pulleywhich is typically addressed by treatment. The causes of trigger fingeras well as with other stenotic soft tissue scenarios includes overuse,inflammatory condition, diabetes and trauma.

Several non-surgical methods for treating constricted soft tissue,including trigger finger, are well known in the art, including splintingand steroid injection. Surgical treatment is designed to release theconstricted soft tissue. For the example, with the trigger fingermalady, the goal of releasing the A-1 pulley is achieved by cutting orremoving part of the stenotic tissue. The surgery procedure may beperformed in the operating room or an office setting using manydifferent tools. Endoscopes, trigger release devices with fixed blades,finely pointed needles and even open surgical techniques with standardscalpels or scissors are currently the type of procedures andinstrumentation used. Problems with the current surgical techniquesinclude multiple incisions or entry wounds to the hand, the ongoing riskto adjacent neurological or vascular structures due to the proximity ofthe target soft tissue. For the example, with trigger finger surgicaltreatments, post-operative complications may include damage to theadjacent digital artery or digital nerve.

Accordingly, developing a new surgical instrument device and acorresponding surgical method to decrease the likelihood ofintraoperative complications when releasing soft tissue and resultantlessened morbidity, would be desirable.

SUMMARY OF THE INVENTION

The present invention satisfies the need for an improved surgicalinstrument used to release the soft tissue of patients suffering fromphysical symptoms resulting from constricted or stenotic tissue and theneed for an improved method of using a surgical instrument to treatconstricted soft tissue in a patient.

The present invention provides in one aspect, a surgical instrument forreleasing soft tissue that has a handle that includes proximal anddistal ends with a longitudinal axis that extends between these ends.The surgical instrument also has a tube that includes a first end and asecond end with a longitudinal axis extending between these two ends.The first end is shaped to assist with the insertion of the surgicalinstrument into the human body with the second end constructed to attachto the distal end of the handle. The surgical instrument furtherincludes a blade member. The blade member is made to slide and movealong the longitudinal axis of the tube to release adjacent soft tissue.

The present invention provides in another aspect, a surgical instrumentfor cutting soft tissue that includes a handle having both proximal anddistal ends and a longitudinal axis extending between these ends. Thesurgical instrument also has a substantially hollow tube that has afirst end and a second end with a longitudinal axis extending betweenthese two ends. The first end is shaped to assist in inserting thesurgical instrument into the human body. The second end is constructedto attach to the distal end of the handle. The surgical instrumentfurther includes a blade member that is built to slide and move alongthe longitudinal axis of the substantially hollow tube to release thepatient's soft tissue. The guard member is also part of the presentsurgical instrument invention and has a hood portion and a captureportion. The hood portion is connected to the blade member with thecapture portion being positioned distal to the blade member to move awaysurrounding tissue when the blade member moves relative to thesubstantially hollow tube. The surgical instrument also has an actuatorthat is operationally connected to the blade member. When the actuatoris actuated the blade member moves along the longitudinal axis of thesubstantially hollow tube to cut soft tissue after the surgicalinstrument has been inserted into the human body.

The present invention provides in yet another aspect, a method forreleasing soft tissue within a patient that includes the step ofsurgically creating an opening in the skin of the patient that isproximate to the soft tissue to be released. The method includes thestep of inserting a surgical instrument into the opening that has ahandle having proximal and distal ends and a longitudinal axis thatextends between the ends. The surgical instrument also has a tube thatincludes a first end and a second end with a longitudinal axis extendingbetween these ends. The first end of the tube is made to assist with theinsertion of the surgical instrument into the patient and the second endof the tube is constructed to be attached to the distal end of thehandle. The surgical instrument also includes a blade member that isconfigured to slide and move relative to the tube along the tube'slongitudinal axis. The method also includes the step of advancing thetube element of the surgical instrument into the opening of the patientto position the first end of the tube adjacent the target soft tissue. Afurther step of the method is to actuate or move the blade member alongthe longitudinal axis of the tube, engaging the soft tissue and placingthe blade member in an operable position for the further step of cuttingthe soft tissue with the blade member to release the constricted softtissue.

The present invention provides in another aspect, a surgical instrumentkit for releasing soft tissue. The kit includes a plurality of surgicalinstruments. Each of the plurality of surgical instruments have a handlethat includes a proximal end and distal end with a longitudinal axisextending between the ends. Each of the plurality of surgicalinstruments also include a tube having a first end and a second end witha longitudinal axis extending between these two ends. The first end ismade to facilitate inserting the surgical instrument into the human bodywith the second end being constructed to attach to the distal end of thehandle. Each of the plurality of surgical instruments also include ablade member that is made to slide and move relative to the tube alongthe tube's longitudinal axis. In addition, each of the plurality ofsurgical instruments have a guard member that is made with a hoodportion and a capture portion. The hood portion is connected to theblade member with the capture portion being positioned distal to theblade member to displace and protect surrounding tissue when the blademember is moved along the longitudinal axis of the tube. Each of theplurality of surgical instruments may also include an actuator that isoperationally connected to the blade member so that when the buttonmember is actuated, the blade member moves along the tube's longitudinalaxis of the tube to cut the constricted soft tissue within the humanbody.

Further, additional features and advantages are realized through thetechniques of the present invention. Other embodiments and aspects ofthe invention are described in detail herein and are considered a partof the claimed invention.

BRIEF DESCRIPTION OF THE DRAWINGS

The subject matter which is regarded as the invention is particularlypointed out and distinctly claimed in the claims at the conclusion ofthe specification. The foregoing and other objects, features andadvantages of the invention are apparent from the following detaileddescription taken in conjunction with the accompanying drawings inwhich:

FIG. 1 is a perspective view of one embodiment of a surgical instrumentused for releasing soft tissue in the body, in accordance with an aspectof the present invention;

FIG. 2 is an enlarged side elevational view of a first end of a tube ofthe surgical instrument of FIG. 1, in accordance with an aspect of thepresent invention;

FIG. 3 is an enlarged perspective view of a blade member with attachedguard member disposed within the tube of the surgical instrument of FIG.1, in accordance with an aspect of the present invention;

FIG. 4 is a cross-section, side elevational view of the surgicalinstrument of FIG. 1 taken along line 4-4, showing a coupling mechanismthat operatively connects the blade member and the button member, inaccordance with an aspect of the present invention;

FIG. 4A is an enlarged cross-section, side elevational view of a portionof the surgical instrument of FIG. 1 taken along line 4-4, showing theblade member attached to the coupling mechanism that attaches to thebutton member, in accordance with an aspect of the present invention;

FIG. 5 is a perspective view of a human hand following a surgicalincision being made on the palmar side of a hand, in accordance with anaspect of the present invention;

FIG. 6 is a perspective view of the human hand showing the insertion ofthe tube of the surgical instrument of FIG. 1 into the incision on thepalmar side of the hand, in accordance with an aspect of the presentinvention;

FIG. 7 is a cross-sectional view through the patient's finger of theinserted surgical instrument of FIG. 1, showing the first end of thetube between a tendon sheath and a tendon, in accordance with an aspectof the present invention; and

FIG. 8 is a cross-sectional view through the patient's finger of theinserted surgical instrument of FIG. 1, showing the first end of thetube between the tendon sheath and the tendon with the capture portionof the guard member engaging the tendon sheath as the blade member cutsthe tendon sheath to release the soft tissue, in accordance with anaspect of the present invention.

BEST MODE FOR CARRYING OUT THE INVENTION

Generally stated, disclosed herein is a surgical instrument for use toperform subcutaneous soft tissue release surgical procedures. Thesurgical instrument typically has a handle, a tube, a blade member witha connected guard member and an actuator to control the movement of theblade member. Also, described herein is a method for using the surgicalinstrument to release percutaneous soft tissue within the human body.Further, described is a surgical instrument kit with modular componentsincluding handles, tubes and blade members for use to release softtissue within the human body. The invention or surgical device willgenerally be referred to herein as a “surgical instrument” or simply“instrument” for ease of discussion. Further, the use of the term“button member” herein should not in any way be interpreted as limitingthe function of the element to having to be depressed or inserted into ahole or loop to operate. The term “button member” was used herein solelyto describe a knob-like member or actuator and such term was notintended to limit or restrict in any way the element's function in thedisclosed invention. In addition, the embodiments of the invention asdescribed herein will typically be used in surgeries involving thereleasing or cutting of soft tissue structures, but it should beunderstood by one skilled in the art that the surgical instrument is inno way limited to just such surgeries. The invention may be used for anumber of other surgical procedures and methods including, but notlimited to the cutting of bones, muscles, connective tissue, vascularstructures, nervous tissue, fascia releases and organ dissection. Inthis regard, the surgical instrument may be used to cut otherconstricted tissue in all parts of the body. As noted, constricted softtissue may effect in some manner, tendons, ligaments, nerves, veins,arteries, bones and muscles as well as other tissue types and organs.Therefore, it is contemplated that the disclosed surgical instrument maybe used to treat stenosing tenosynovitis of the dorsal compartment ofthe wrist, carpal tunnel syndrome, cubital tunnel syndrome, tarsaltunnel syndrome, plantar fascitis and any other generically constrictedor entrapped above tissues/structures in the body.

In this detailed description and the following claims, the wordsproximal, distal, anterior, posterior, medial, lateral, superior andinferior are defined by their standard usage for indicating a particularpart of the human body or instrument according to the relativedisposition of the particular part or directional terms of reference.For example, “proximal” means the portion of the instrument nearest thetorso, while “distal” indicates the portion of the instrument farthestfrom the torso. As for directional terms, “anterior” is a directiontowards the front side of the body, “posterior” means a directiontowards the rear-side of the body, “medial” means towards the midline ofthe body and “lateral” is a direction towards the sides or away from themidline of the body.

FIG. 1 shows the general arrangement of a surgical instrument 10 for useto cut and release soft tissue within the human body, in accordance withan aspect of the present invention. Surgical instrument 10 includesgenerally a handle 100 having a proximal end 101 and a distal end 102and a slot 104. Surgical instrument 10 further includes a tube 200having a first end 201, a second end 202 and a slot 204 that extendsalong a longitudinal axis 203 and is disposed at least partially alongthe superior surface 207 of tube 200. As seen in FIG. 1, tube 200 iscurvilinear, although it would be obvious to one skilled in the art thattube 200 may also be linear or straight. The arc of curvature 205 may bevariable or changed in the event flexible material is used to constructtube 200 or fixed at a certain curvature for rigid material. Curve 205functions to assist with the insertion of tube 200 into the surgicalopening of a patient and facilitate continued advancement of tube 200though the soft tissue of the patient to allow for appropriatepositioning before the blade member 300 is operatively positioned.Further, as seen in FIGS. 1 and 4, tube 200 has a generally cylindricalcross-section, but it would be obvious to one skilled in the art thattube 200 could be comprised of one or more cross-sectional shapes,including, but not limited to rectangular, oval, I-beam or other shapes.Tube 200 is usually fabricated from a rigid material, such as stainlesssteel or another surgical steel, polyvinyl chloride (PVC),polytetrafluoroethylene (PTFE), expanded polytetrafluoroethylene(ePTFE), acryonitrile butadiene styrene (ABS) or any other suitablerigid metal or polymer material. Alternatively, tube 200 may beconstructed from a flexible plastic or ductile/pseudo-elastic metal thathas sufficient flexibility and strength to allow the surgeon to manuallybend tube 200 and also have adequate rigidity to retain such a bendduring the use of surgical instrument 10. Such flexibility of tube 200may facilitate the proper placement of surgical instrument 10 withrespect to the surgical site and the target soft tissue structure.

As shown in FIGS. 4 and 4A, tube 200 is generally hollow over its entirelength to form an inner cavity 208 that is sized to accommodate acoupling mechanism 301 that connects blade member 300 to the buttonmember 500 or more generally referred to as actuator. In operation,coupling mechanism 301 correspondingly slides within inner cavity 208 oftube 200 and the inner cavity 106 of handle 100 when button member 500is moved either in a distal or proximal direction. Inner cavities 208,106 are constructed to receive various sizes of coupling mechanism 301and allow for blade member 300 to slide along superior surface 207 oftube 200.

FIGS. 4 and 4A also show slot 204 that is sized to receive a portion ofblade member 300 that connects to coupling mechanism 301. Slot 204 runsgenerally the entire length of tube 200, although it would be obvious toone skilled in the art to construct tube 200 with a slot that onlypartially extends over the length of tube 200. Slot 204 is orientedalong longitudinal axis 203 providing for translation movement along theaxis 203 when button member 500 actuates blade member 300. The width ofslot 204 is toleranced to accommodate blade member 300 while maintainingminimal medial-lateral movement or toggle relative to tube 200 whenblade member 300 is moved along longitudinal axis 203.

First end 201 of tube 200 is shown in FIG. 2 as a conical shape with ablunted tip. It is contemplated that the shape of first end 201 may bevariable according to the end use of surgical instrument 10.Specifically, first end 201 may be conical shape as shown, afrustoconical shape, a bulbous shape, a beveled configuration, a roundedshape, a spherical shape, an elliptical shape or have a blunted end. Theshaped first end 201 may be rigidly fixed to tube 200, or alternatively,detachably connected to allow for interchangement of the various shapedend pieces of first end 201. Having such modularity between tube 200 andfirst end 201 allows the surgeon to customize surgical instrument 10 forspecific operative situations and purposes. Although not shown, it iswell understood that when first end 201 is modular in design, theattachment mechanism between tube 200 and first end 201 may includethreads, locking pins, spring clips, spring ball/catch or a twist lock.An alternative embodiment of tube 200 may also include a structure ordetent mechanism positioned near first end 201 that may engage the blademember 300 and guard member 400 construct. Although not shown, suchstructure may be located on superior surface 207 and will function toeither produce an audible sound or a tactile sensation to the surgeonwhen the blade member 300 and guard member 400 construct comes intocontact with the structure on tube 200. This structure provides someform of sensory feedback to the surgeon indicating the distal positionof the construct following insertion of tube 200 into the surgicalopening.

As shown in FIG. 1, second end 202 functions to attach tube 200 todistal end 102 of handle 100. Second end 202 may rigidly attach tube 200to handle 100, or alternatively, second end 202 may be configured toallow for detachment by the surgeon. Allowing for suchinterchangeability provides the surgeon with the ability to attachvarious lengths, shaped and sized tubes 200 in response to a presentedsurgical situation. Such modularity between tube 200 and handle 100provides the surgeon with increased operative flexibility andcustomization. Although not shown, it is well understood by thoseskilled in the art that several attachment mechanism may be employed tooperatively connect tube 200 and handle 100 by second end 202 including,threads, twist lock, locking pins, spring clips, spring balls or aspring catch.

In the depicted embodiment of FIG. 1, surgical instrument 10 may beentirely constructed of metal, plastic, or other rigid and sturdymaterials and will be intended to be reusable. In an alternativeembodiment, surgical instrument 10 may be designed to be single use anddisposable. The reusable embodiment of surgical instrument 10 willgenerally be sterilized in any manner known to those of ordinary skillin the art between patients and, consequently, will generally be moreeconomical over time than disposable devices. Constructing tube 200 outof a rigid, reusable material such as metal also provides for increasedstrength which will generally make tube 200 more resistant to bending orbreaking in the event the surgeon needs to apply increased pressure orforce to first end 201 in order to advance tube 200 within the surgicalopening to perform the desired procedure.

It is further contemplated that because of the modularity design ofsurgical instrument 10 that various elements will be constructed fromreusable materials while other elements are constructed from disposablematerials. For example purposes only, handle 100 may be fabricated frommetal, ABS or PVC while tube 200 is made from a disposable material,allowing the user to disconnect and discard tube 200 after a single use.

An embodiment of a surgical instrument kit is contemplated and describedin more detail below. For example, the kit may include a reusable handle100 with a series of various sized, angled/arced and shaped disposableassembled tube constructs with each construct including tube 200 with aninserted blade member 300, and attached coupling mechanism 301 and guardmember 400. Other iterations of kit assemblies may include reusablehandle-tube constructs with disposable blade members 300 and guardmembers 400. It would be well understood by one skilled in the art thatseveral combinations and iterations of a surgical instrument kit,including kits that have other accessory surgical tools andmiscellaneous surgical paraphernalia, could be assembled and woulddepend upon the surgical application and type of procedure in which thesurgical instrument 10 would be used.

FIGS. 1, 4 and 4A further show handle 100 that includes proximal end101, distal end 102 with longitudinal axis 103 extending between thesetwo ends. Handle 100 also includes a slot 104 that is positioned on thesuperior surface 107 and extends generally parallel to longitudinal axis103. Slot 104 is sized to receive button member 500 and accommodatetranslational movement of button member 500 along longitudinal axis 103.

As depicted in the cross-sectional views of FIGS. 4 and 4A, handle 100includes an inner cavity 106 that is positioned directly adjacent toslot 104 and extends through distal end 102. The size and configurationof inner cavity 106 allows for the passage of coupling mechanism 301 andbutton member 500. Inner cavity 106 also includes at least two innerchannels 105 running generally parallel to longitudinal axis 103. Innerchannels 105 are configured to hold the outer flanges 502 of buttonmember 500. Outer flanges 502 in cooperation with inner channels 105stabilize button member 500 while button member 500 slides within slot104. Inner channels 105 also function to keep button member 500 fromrotating while being actuated. Although not shown, button member 500 mayengage a structure within slot 104 or more specifically inner channel105 that either generates a sound or a tactile sensation that providethe surgeon with feedback that button member 500 has been moved to themost distal position and correspondingly, blade member 300 and guardmember 400 construct is now located at its most distal position relativeto tube 200. FIGS. 4 and 4A further show button member 500 including aconnection post 503. Connection post 503 extends from the inferioraspect of button member 500 and attaches to the proximal end of couplingmechanism 301. When in operation, button member 500 is actuated or slidwithin slot 104 by the surgeon, causing a corresponding sliding movementof blade member 300 within slot 204 of tube 200. Movement of buttonmember 500 translates to direct movement of blade member 300 viacoupling mechanism 301 that mechanically connects these two structures.

FIG. 4 further shows handle 100 having at its proximal end 101, amoveable cutting blade 600. Cutting blade 600 when not in use is fullyretracted into a cavity 603 in order to avoid any injury to the surgeonwhen the surgeon is using surgical instrument 10 to release soft tissueusing the other operative end of the device. Changing the position ofcutting blade 600 is accomplished by actuating button 601 to unlockcutting blade 600 and permit it to extend from proximal end 101 throughcavity 603. A connector 602 couples button 601 to cutting blade 600 witha spring catch or ball acting in conjunction with button 601 to securecutting blade 600 either in the extended or retracted position.

As seen in FIG. 1, the outer surface of handle 100 is usually configuredto fit into the hand of the surgeon. Various non-slip surface texturesand shaping may be performed/applied to superior surface 107 to ensureacceptable comfort and dexterity for the surgeon when the device isbeing used.

FIG. 3 shows guard member 400 coupled to blade member 300. As shown,blade member 300 includes a cutting edge 302 disposed along the distalportion of blade member 300. Cutting edge 302 as shown is orientedgenerally perpendicular relative to tube 200 and is defined by astraight line. Cutting edge 302 is usually fabricated from a metallicmaterial, although a rigid polymer may be used. It would be understoodby one skilled in the art that cutting edge 302 may also be positionedat an acute angle relative to tube 200. In addition, cutting edge 302instead of being straight may also be defined by an angle or by an arcrelative to the sagital plane or longitudinal axis to facilitate cuttingand releasing any soft tissue that is engaged. Further, cutting edge 302may be modular relative to blade member 300 to allow forinterchangeability in the event of a changed clinical situation orsurgical procedure. Connection mechanisms between a modular cutting edge302 and blade member 300 are well known in the art. Typically, connectedto the superior surface 303 of blade member 300 is the hood portion 401of guard member 400. As seen in cross-sectional view FIG. 4A, theinferior portion 304 of blade member 300 is also connected to couplingmember 301 that is then connected to button member 500. As disclosedabove, coupling mechanism 301 connects button member 500 to blade member300 and passes along inner cavities 106, 208. Coupling mechanism 301operates to correspondingly move blade member 300 along slot 204 of tube200 when button member 500 is moved. It is not shown, but iscontemplated that coupling mechanism 301 may be detachable from eitherbutton member 500, or alternatively, from blade member 300, thusallowing blade member 300 to be modular in design and allow forinterchangeability to address various clinical conditions and surgicalprocedures if different cutting edge sizes, angulations or shapes arenecessary while keeping tube 200 and handle 100 construct intact.

Guard member 400 as seen in FIGS. 3 and 4A includes hood portion 401, acapture portion and a distal tip 403. Generally, the inferior surface ofhood portion 401 is rigidly attached to superior surface 303, althoughit is contemplated that an alternative embodiment of the invention mayhave hood portion 401 that is detachable from superior surface 303allowing for interchangeability between various sizes and configurationsof guard member 400 and blade member 300. Extending from and slanting inan inferior direction is capture portion 402. Capture portion 402includes a width 404 that is configured to entrap or pressingly engagetissue between an inferior surface 405 of capture portion 402 andsuperior surface 207 of tube 200. When in operation, the superiorsurface 406 of capture portion 402 functions to move or displacesurrounding tissue away from blade member 300 when tube 200 is insertedinto a surgical opening and blade member is moved along tube 200 to itsoperative position before cutting the target soft tissue. Superiorsurface 406 also functions to protect adjacent structures (e.g., nerves,vascular structures) from cutting edge 302. As shown in FIG. 3, superiorsurface 406 of capture portion 402 is generally flat, although notshown, it should be understood that superior surface 406 may also beangular or shaped in a plow-like configuration to facilitate tissuemovement and protection. Additionally, it would be well understood byone skilled in the art that width 404 may also be varied or tapereddepending on the surgical procedure that may be performed with surgicalinstrument 10. Varying width 404 may be accomplished by having a modularcapture portion 402 that can be detached from hood portion 401. Width404 may also be changed by having capture portion 402 be expandable inthe medial-lateral dimension.

As shown in FIGS. 3, 4 and 4A, guard member also include distal tip 403that is typically fabricated from a flexible material. Distal tip 403 isconfigured to be an upward projecting arc shaped element that isconfigured similar to a ski tip. Alternative configurations of distaltip 403 are contemplated to include upward oriented chamfers, bevels,wedges, cones, tapers, spheres and drifts. The purpose of distal tip 403is to facilitate the passage of soft tissue beneath the construct toallow for engagement with cutting edge 302 of blade member 300. FIG. 3depicts distal tip 403 as being integral to capture portion 402,although an alternative embodiment of the invention may include a distaltip 403 that can be uncoupled from capture portion 402 and, thus beremovable and modular to allow the surgeon to interchange variousdifferent tip configurations that best suits a presented clinical orsurgical application. Methods of connecting distal tip 403 to captureportion 402 are well know in the art and may include press fit, springballs, spring catches and locking pins.

Referring now to FIGS. 5-9, one example of a method for releasing softtissue in the case of trigger finger will now be discussed inconjunction with the above-illustrated embodiment of the surgicalinstrument. As seen in FIG. 5, the method includes surgically creatingan incision 700 just distal to the metacarpal phalangeal joint crease inthe palm. Proximal cutting blade 600 may be used to create incision 700.It should be noted that the orientation of incision 700 as shown inFIGS. 5 and 6 is transverse, but such orientation may be changed at thediscretion of the surgeon. The method further includes insertingsurgical instrument 10, or more specifically, tube 200 through incision700 as shown in FIG. 6. As disclosed above, surgical instrument 10generally includes handle 100 with proximal end 101 and distal end 102,tube 200 with first end 201 and second end 202, and longitudinal axis203. First end 201 is constructed to facilitate the insertion of tube200 through incision 700 with second end 202 being configured to attachor detachably couple to distal end 102 of handle 100. In addition,surgical instrument 10 to be used in the method may include blade member300 that slidingly engages tube 200 and is moveable relative to tube 200along longitudinal axis 203.

As shown in the cross-sectional view of FIG. 7, the method also includesadvancing tube 200 within incision 700 with first end 201 bluntlyentering the flexor tendon sheath 701 to position first end 201 adjacentto the target soft tissue. When tube 200 has been advanced throughflexor tendon sheath 701 to the proximal end of the A1 pulley, themethod will further include actuating or moving blade member 300 alonglongitudinal axis 203 to contact and engage the soft tissue and placeblade member 300 or more specifically, cutting edge 302 in operableposition relative to the A1 pulley structure.

Cross-sectional view FIG. 8 shows tube 200 in final position with blademember 300 in operable position relation to A1 pulley 702. Blade member300 is then moved distally to the distal end of the A1 pulley 702slicing off a section of the pulley and releasing the soft tissue orflexor tendon sheath 701. It should be noted that when advancing tube200 within flexor tendon sheath 701, guard member 400 and morespecifically, hood portion 401 and capture portion 402 push or movesurrounding soft tissue and other structures away from flexor tendonsheath 701 and blade member 300 to prevent damage to the nerves, veins,and arteries that are adjacent to the flexor tendon 703 and flexortendon sheath 701. As seen in FIG. 8, capture portion 402 functions totrap a section of flexor tendon sheath 701 to allow cutting edge 302 todivide a section, or the entire length of flexor tendon sheath 701depending on the degree of constriction or stenosis presented.

Although not shown, after a section of A1 pulley 702 has been cut, oralternatively, A1 pulley has been divided, the method includesextracting and removing surgical instrument 10 from the patient'sfinger, followed by closing the incision using a suture or closure tape.

As disclosed above, the embodiment of surgical instrument 10 describedherein may be modular in design, thereby allowing the operating surgeonto choose from a surgical instrument kit that includes a multiple ofdifferently sized and shaped elements, including handles 100, tubes 200,blade members 300 and guard members 400. The surgical instrument kitprovides the operating surgeon with the flexibility to mix and matchappropriate sized and configured elements of the surgical instrument tobest address the presented clinical situation and surgical procedure.The kit typically is comprised of a series or plurality of surgicalinstruments with each surgical instrument 10 including handle 100, tube200, button member 500, blade member 300 and guard member 400. Thestructure and geometrical dimensions of the above elements of surgicalinstrument 10 are much the same as those designated by the same numeralwhich were described above in reference to FIGS. 1-4A. For the sake ofbrevity, said elements will not be further discussed at this point.

Generally, the surgical instrument kit may be comprised of variouslengths, shapes or curvatures and cross-sectional sizes and shapes oftubes 200. Each tube 200 will have first and second ends 201, 202allowing for attachment to distal end 102 of handle 100. It is furthercontemplated that the surgical instrument kit may include a plurality ofdifferent sized and configured blade members 300 and corresponding guardmembers 400 with a modular coupling mechanism that allows for easyplacement and attachment to tube 200 and handle 100. Having a pluralityof differing sized and configured blade members 300 and correspondingguard members 400 allows the operating surgeon the ability to pick acutting blade that most closely matches the need for a specificprocedure. Additionally, the surgical instrument kit will have aplurality of handles 100. Again, the plurality of handles 100 gives theoperating surgeon the ability to attach whatever sized handle 100 andbutton member 500 is appropriate for the surgical procedure to beperformed. Each of the plurality of handles 100 may be sized and shapeddifferently to best fit the needs of the operating surgeon.

Having a surgical instrument kit that includes modular elements of thesurgical instrument 10 can provide certain benefits including decreasedinstitutional costs while providing to the operating surgeon the abilityto customize an instrument for a specific clinical application whileperforming the surgical procedure.

Although the preferred embodiments have been depicted and described indetail herein, it will be apparent to those skilled in the relevant artthat various modifications, additions and substitutions can be madewithout departing from its essence and therefore these are to beconsidered to be within the scope of the following claims.

What is claimed is:
 1. A surgical instrument for releasing soft tissue,the surgical instrument comprising: a handle having proximal and distalends, and a longitudinal axis extending therebetween; a tube having afirst end and second end, a longitudinal axis extending therebetween anda slot disposed at least partially along a superior surface of the tubeand extending along the longitudinal axis, the first end beingconfigured to facilitate the insertion of the surgical instrument intothe human body and the second end being configured to couple to thedistal end of the handle; a blade member having a cutting edge, whereinthe blade member is configured to slide within the slot of the tube withthe cutting edge extending exterior to the tube to release soft tissue;and a guard member, the guard member comprising a hood portion and acapture portion, wherein when an inferior surface of the hood portion isconnected to a superior surface of the blade member, the capture portionis positioned distal to the cutting edge of the blade member and extendsfrom and slants in an inferior direction from the hood portion todisplace surrounding tissue when the blade member is moved within theslot, and the guard member moves with the blade member.
 2. The surgicalinstrument of claim 1, wherein the cutting edge of the blade member isoriented substantially perpendicular relative to the tube.
 3. Thesurgical instrument of claim 1, wherein the capture portion of the guardmember is fabricated from a flexible material to pressingly engage softtissue structures between the capture portion and the tube.
 4. Thesurgical instrument of claim 1, wherein the capture portion furthercomprises a distal tip, the distal tip is configured as at least one ofan arc shape, a chamfer, a taper, a cone, a wedge, a spherical shape, adrift and a bevel to facilitate the passage and engagement of softtissue structures when the blade member is moved relative to the tube.5. The surgical instrument of claim 1, wherein the first end of the tubeis configured as at least one of a conical shape, a frustoconical shape,a bulbous shape, a beveled configuration, a rounded shape, a sphericalshape, an elliptical shape and blunted.
 6. The surgical instrument ofclaim 1, wherein the tube is curved along its longitudinal axis tofacilitate the insertion of the surgical instrument into the human body.7. The surgical instrument of claim 1, wherein the handle furthercomprises a slot, the slot being disposed in a top surface thereof toreceive an actuator, wherein the slot extends along the longitudinalaxis of the handle to facilitate actuation of the actuator therein. 8.The surgical instrument of claim 7, wherein the actuator isoperationally connected to the blade member, whereby actuation of theactuator moves the blade member along the longitudinal axis of the tubeto facilitate the release of soft tissue.
 9. The surgical instrument ofclaim 1, wherein the handle further comprises a cutting blade, thecutting blade being operatively connected to the proximal end such thatthe cutting blade is retractable into the proximal end of the handlewhen not in use.
 10. The surgical instrument of claim 1, wherein thetube is fabricated from at least one of a flexible material and a rigidmaterial.
 11. A surgical instrument for cutting soft tissue, thesurgical instrument comprising: a handle having proximal and distalends, and a longitudinal axis extending therebetween; a substantiallyhollow tube having a first end and second end, a longitudinal axisextending therebetween and a slot disposed on a top surface of the tubeand extending along the longitudinal axis, the first end beingconfigured to facilitate the insertion of the surgical instrument intothe human body and the second end being configured to couple to thedistal end of the handle; a blade member having a cutting edge, theblade member being configured to slidingly engage the slot of thesubstantially hollow tube with the cutting edge extending outside thetube to release soft tissue; a guard member, the guard member comprisinga hood portion and a capture portion, wherein when an inferior surfaceof the hood portion is connected to a superior surface of the blademember, the capture portion is positioned distal to the blade member andextends from and slants in an inferior direction from the hood portionto displace surrounding tissue when the blade member moves within theslot and the guard member moves with the blade member; and an actuatorhaving a first end and a second end, wherein the blade member isoperationally connected to the first end, whereby actuation of theactuator moves the blade member along the slot of the substantiallyhollow tube to cut soft tissue following the insertion of the surgicalinstrument into the human body.
 12. The surgical instrument of claim 11,wherein the capture portion of the guard member is fabricated from aflexible material, whereby when the blade member is moved relative tothe substantially hollow tube the capture portion pressingly engagessoft tissue structures between the capture portion and the substantiallyhollow tube.
 13. The surgical instrument of claim 11, wherein the shapeof the first end of the substantially hollow tube is at least one ofconical, frustoconical, bulbous, beveled, rounded, circular, ellipticaland blunted.
 14. The surgical instrument of claim 11, wherein thesubstantially hollow tube is curved along its longitudinal axis tofacilitate the insertion of the surgical instrument into the human body.15. The surgical instrument of claim 11, wherein the handle furthercomprises a slot, the slot being disposed in a top surface thereof toreceive the actuator, wherein the slot extends along the longitudinalaxis of the handle to facilitate actuation of the actuator therein. 16.The surgical instrument of claim 11, wherein the actuator furthercomprises a button member, the button member being fixed to the secondend of the actuator.
 17. A surgical instrument kit for releasing softtissue, the kit comprising: the surgical instrument of claim 1; and atleast a second surgical instrument comprising: a handle having proximaland distal ends, and a longitudinal axis extending therebetween; a tubehaving a first end and second end, a longitudinal axis extendingtherebetween and a slot positioned at least partially along a superiorsurface of the tube and extending along the longitudinal axis, the firstend being configured to facilitate the insertion of the surgicalinstrument into the human body and the second end being configured tocouple to the distal end of the handle; a blade member having a cuttingedge, the blade member being configured to slidingly engage the slot ofthe tube with the cutting edge extending exterior to the tube; a guardmember, the guard member comprising a hood portion and a captureportion, wherein an inferior surface of the hood portion is connected toa superior surface of the blade member and the capture portion ispositioned distal to the cutting edge of the blade member and extendsfrom and slants in an inferior direction from the hood portion todisplace surrounding tissue when the blade member is moved within theslot and the guard member moves with the blade member; and an actuator,the actuator is operationally connected to the blade member, wherebyactuation of the actuator moves the blade member along the slot to cutsoft tissue following the insertion of the surgical instrument into thehuman body.
 18. The surgical instrument kit of claim 17, wherein theblade member of the surgical instrument of claim 1 and the at leastsecond surgical instrument wherein the cutting edge of the blade memberis oriented substantially perpendicular relative to the tube along theslot.
 19. The surgical instrument kit of claim 17, wherein the blademember of the surgical instrument of claim 1 and the at least secondsurgical instrument wherein the cutting edge of the blade member isangled relative to the tube.
 20. The surgical instrument kit of claim17, wherein the blade member of the surgical instrument of claim 1 andthe at least second surgical instrument is detachably coupled to a firstend of the actuator , the actuator further comprises a button memberfixed to a second end of the actuator, whereby the blade member ismodular.
 21. The surgical instrument kit of claim 17, wherein thesurgical instrument of claim 1 and the at least second surgicalinstrument further comprises a first modular tube and an at least secondmodular tube, the first modular tube and the at least second modulartube comprise a first end and second end, and a longitudinal axisextending therebetween, the first end being configured to facilitate theinsertion of the surgical instrument into the human body and the secondend being configured to detachably couple to the distal end of thehandle.
 22. The surgical instrument kit of claim 21, wherein each of thefirst modular tube and the at least second modular tube are configuredto allow the blade member to move relative to the tube along thelongitudinal axis when the modular tube is coupled to the handle and thebutton member is actuated.
 23. The surgical instrument kit of claim 21,wherein for each of the first modular tube and the at least secondmodule tube the first end is detachably coupled to the tube and isconfigured as at least one of a conical shape, a frustoconical shape, abulbous shape, a beveled configuration, a rounded shape, a sphericalshape, an elliptical shape and blunted.
 24. The surgical instrument kitof claim 21, wherein for each of the first modular tube and the at leastsecond modular tube of modular tubes the tube is curved along itslongitudinal axis to facilitate the insertion of the surgical instrumentinto the human body.
 25. The surgical instrument kit of claim 21,wherein for each of the first modular tube and the at least secondmodular tube the tube is straight along its longitudinal axis tofacilitate the insertion of the surgical instrument into the human body.26. The surgical instrument kit of claim 17, wherein for the surgicalinstrument of claim 1 and the at least second surgical instrument thecapture portion of the guard member is fabricated from a flexiblematerial to facilitate engagement of soft tissue structures between thecapture portion and the tube.
 27. The surgical instrument kit of claim17, wherein for the surgical instrument of claim 1 and the at leastsecond surgical instrument the capture portion further comprises adistal tip, the distal tip is configured as at least one of an arcshape, a chamfer, a taper, a cone, a wedge, a spherical shape, a driftand a bevel to facilitate the passage and engagement of soft tissuestructures when the blade member is moved relative to the tube.
 28. Thesurgical instrument kit of claim 17, wherein for the surgical instrumentof claim 1 and the at least second surgical instrument the handlefurther comprises a slot, the slot being disposed in a top surfacethereof to receive a button member, wherein the slot extends along thelongitudinal axis of the handle to facilitate actuation of the buttonmember therein.